Vertebral malalignment syndrome

According to the discoverer of chiropractic D.D. Palmar, and the father of modern chiropractic B.J. Palmar, malalignment syndrome, also known as “Vertebral sublaxation complex” (VSC), is a disorder characterized complex pathological processes that can be summarized as the following:

1. Vertebral joint articulation disturbance which can be due to ligamentous laxity, post-traumatic event, or due to degenerative changes (Spondyloarthropathy). Vertebral malalignment commonly results in rotation of one vertebra over the other initially, which will progress if not corrected to retro- or anterolithiasis due to bilateral pedicular fracture (spondylosis

2. Distortion of the pelvic ring associated with compensatory scoliosis of the lumbar vertebral column, which in turn causes compensatory distortion of the upper thoracic and cervical column. Rotational pelvic malalignment is detected in 80% of cases, where the right or left pelvic bone rotates forward and the other usually compensates by rotating backward relative to the sacroiliac/coccygeal bone 

3. Compensatory changes in the soft tissue structures resulting in uneven back muscles contraction, which predispose to chronic back pain and myofascial trigger points formation

4. A long-standing vertebral malalignment causes intervertebral disc herniation disorder due to torsion of the annulus in a clockwise direction as a result of rotatory movement of one vertebra over the other

5. Uncommonly, vertebral malalignment can cause regional and distant somatovisceral dysfunction attributed to:

a) Spinal kinesiopathology: the spinal mechanics and motion irregularities resulted from pelvic obliquity can affect the genitourinary structures for example

b) Neuropathy: due to impingement or stretching of the nearby neural tissues

c) Myopathy: due to myofascial trigger points formation in the regional muscular structures 

d) Inflammation: fascial tension that arises from rotatory vertebral malalignment impedes the interstitial and neuro-vasculo-lymphatic flows causing regional wastes accumulation, hypoxia, local inflammation and edema

e) Patho-anatomical changes: when all the past four components persists, local tissue degeneration occurs


Selected references

1. Bergmann TF, Peterson DH. Chiropractic technique: principles and procedures. 2010; Mosby; 3rd edition

2. Gatterman MI. Foundations of chiropractic: subluxation. 2005; Mosby; 2nd edition

3. Bolton PS. Reflex effects of vertebral sublaxations: the peripheral nervous system. An update. Journal of Manipulative and Physiological Therapeutics 2000; 23(2): 101-103

4. Vernon H. Historical overview and update on sublaxation theories. Journal of Chiropractic Humanities 2010; 17(1): 22-32

5. Good C. The sublaxation syndrome: a condition whose time has come? Journal of Chiropractic Humanities 2004; 11: 38-43   

6. Harris JH. Malalignment: signs and significance. European Journal of Radiology 2002; 42: 92–99